lense 1 or 2, 1 or 2... exam

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dumbstruck - 13 Dec 2005 02:18 GMT

I just recognized a chronic problem in those exams where you have to
repeatedly choose lense setting 1 vs 2. If it is just with me, then
fine, I will take care of it in future... but since it happened with
many eye docs I thought I would bring it up. Simple problem but hard
to explain, and hard to recognize and feed back to the examiner.

I have no problem with most of the process... do you prefer 1
(click-fuzzy, click-fuzzy, click-clear!) or 2? 1 or 2, 1 or 2... fine.
The problem is not getting enough time for the first 1, or the first 1
after a major resetting. You may be given equal time 1 vs 2, but you
didn't see 1 properly since it was preceeded by various partially fuzzy
settings with unpredictable length. By the time they surprise you with
"do you prefer 1" and you are locking into that image, they are already
shooting off to image 2.

Then when you ask for a replay of 1 vs 2, they may decide you are a
dunce and do it so slow you can hardly compare, or maybe they will
decide you mean the choices are too close to call. And other things go
wrong in an environment not conducive to metadiscussion about how to
best do an exam, like you making a too rushed and incorrect choice.
But maybe this will be corrected by the followon choices.

So bottom line, I alert customers to be ready to bring this up if it
happens, and examiners to consider giving more time after the very
first "do you prefer 1?" after a major reset. Other times the #1 view
can usually be anticipated by the repeatitive rythmn of the process...

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Dan Abel - 13 Dec 2005 04:56 GMT

> I just recognized a chronic problem in those exams where you have to
> repeatedly choose lense setting 1 vs 2.

I had a bad experience a few years back. I may have posted this before.

I had back to back appointments, the first with an OD and the second
with an OMD. I had cataract surgery 30 days before, so this will tell
me how it came out, and what to do. I have the first appointment of the
day with the OD. I get there, and there is no one at the registration
desk. I'm there 15 minutes, and there are probably 15 patients. I'm
guessing there are a dozen doctors, both ODs and OMDs. They are popping
their heads out of the doors every few minutes. They need to see their
patients. Their patients need to see them. No can do. Have to
register and make your copay first. I'm guessing that the doctors
deliberately have no access to registration, no computer access.

It's 15 minutes. Two registration people come, and they are really
fast. We all get processed quickly. I see some tech. I think it's an
autorefractor and a puff test. I see the OD. He is major weirded out,
or maybe he is just weird. I have some doubts. It's a really new
office. The latest and the greatest. He does my refraction by remote
control. It's a disaster. He says, "whichisbetteroneortwo?". I look,
I try to decide. The machine makes a really ugly "kachunk". I watch
again. I try to decide. The machine makes another "kachunk". Ok,
that's three. I'm lost. He's done the "whichisbetteroneortwo" while
"two" is still there from the previous pair. This happens several
times. I'm sorry, my mind is on the cataract surgery. I'm trying, but
I don't think he is.

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Dan Abel
dabel@sonic.net
Petaluma, California, USA

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William Stacy - 13 Dec 2005 06:08 GMT

Don't lose sleep over it. The fact is that, at least for the Jackson
cross-cylinder tests for astigmatism powers and axes, the more difficult
it is for you to decide between 2 fuzzy choices, the closer we are to
our endpoint. The more obvious the choices, like one is way clear and
the other way blurred, the farther we are from where we need to be.
Sounds perverse, but that's how it is. And remember, we never decide a
final Rx on one set of choices. It's an accumulation of information that
a good refractionist puts together for you. Having said that, I always
put the final endpoint in the machine at the very end of the subjective
refraction and ask for verification that it is very sharp and clear,
certainly as clear or better than any you've seen during the 1 or 2
ritual...

w.stacy, o.d.

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